Provider Demographics
NPI:1235130006
Name:HILL, DANIEL GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GORDON
Last Name:HILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:G
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1120 W. SOUTH BOULDER ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:720-625-1968
Mailing Address - Fax:720-638-2931
Practice Address - Street 1:1120 W. SOUTH BOULDER ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:720-625-1968
Practice Address - Fax:720-638-2931
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
739667OtherUNITED CONCORDIA